Application of electrically evoked auditory brainstem responses in cochlear reimplantation.

OBJECTIVES

To evaluate the role of electrically evoked auditory brainstem responses (EABRs) in assessing auditory pathway integrity and predicting auditory and speech outcomes in patients undergoing cochlear reimplantation (CRI), especially those with cochlear ossification or complex anatomy.

METHODS

A retrospective analysis was conducted of 40 CRI patients (12 ossification, 28 non-ossification) from 2019 to 2024. Intraoperative and postoperative EABR assessments were performed to evaluate neural responses and guide cochleostomy. Parameters included the elicitation rate, V-wave amplitude, threshold, and Gibson score. Auditory-speech performance was measured by the Categories of Auditory Performance and Speech Intelligibility Rating scales, and word-recognition scores. Regression analyses identified predictors of postoperative outcomes.

RESULTS

The EABR elicitation rate was 100% in non-ossification cases and 80% in ossification cases. Gibson scores were higher, and V-wave thresholds lower, in non-ossification ears (p < 0.05). Latencies and amplitudes did not differ significantly. Auditory-speech outcomes were superior in non-ossification patients. Implantation age, cochlear ossification, and middle-electrode Gibson score significantly predicted postoperative performance; middle-electrode Gibson score correlated most strongly with the disyllabic word recognition rate (R2 = 0.406, p = 0.0007).

CONCLUSIONS

EABRs reliably assess auditory pathway integrity, inform surgical guidance, and predict postoperative auditory-speech outcomes in CRI, especially in ossified or anatomically complex cochleae.

SIGNIFICANCE: The findings support the use of EABRs as a clinical adjunct to improve surgical precision and functional outcomes in challenging CRI cases.